Whenever I mix up words or forget what I was trying to say, I make fun of myself by saying “words are my craft, you know.” It’s funny because it’s true: I have one job, and it is to use words well, which doesn’t seem like much of a tall order. Yet political reporters seem to struggle with this constantly, having been confounded by President Trump’s unprecedentedly wily ways: He lies all the time and is also quite dumb. Four years in, journalists still struggle with this norm-smashing combination of absolute ballsiness and the possibility that he doesn’t know when he’s wrong; hence the general reluctance to call Trump a liar, even after all this time, even when it is the only correct word to describe what he’s doing.
This is how we end up with stories about Trump’s latest attempt to look busy on health care that fail to convey exactly how little he’s accomplished. A Washington Post story last week reported that Trump “capped his fruitless four-year journey to abolish and replace the Affordable Care Act”—alright, a good start!—“by signing an executive order Thursday that aims to enshrine the law’s most popular feature while pivoting away from a broader effort to overhaul the nation’s health insurance system.”
Ah. No. Not quite. The executive order did not aim to enshrine Obamacare’s most popular feature, the protection of preexisting conditions. It simply stated that it “has been and will continue to be the policy of the United States to give Americans seeking healthcare more choice, lower costs, and better care and to ensure that Americans with pre-existing conditions can obtain the insurance of their choice at affordable rates.” Obviously that first part will be news to millions of Americans who still pay hundreds of dollars a month for health care that would wipe out their bank balance if they actually tried to use it. But the latter part is the non-news here: In no way can it accurately be said that this executive order aimed to enshrine the ACA’s protections on preexisting conditions.
You have to read quite a bit further down the Post story to find out what turns the executive order from pointless into fraudulent: The ongoing lawsuit, filed by the Trump administration and 18 Republican states, that seeks to invalidate the entire ACA, preexisting condition protections and all. The executive order Trump signed would not magically protect patients if that lawsuit is successful at the RBG-less Supreme Court; that is not how law works. It cannot be said, therefore, that the executive order aims to protect those patients. What it aims to do is deceive them.
Why is the president and his party so determined to lie to the public on the ACA, helped along by a media that struggles to accurately explain what is happening? It’s quite simple: The party is committed to repealing the ACA because it fundamentally does not believe that insurers, even as they make hundreds of billions of dollars a year, should be restricted in how they make money. But it recognizes that Americans are overwhelmingly in favor of protecting themselves from losing coverage. It recognizes that it cannot possibly defend making things so much worse, because the situation as it stands now is already so utterly intolerable. So it squares the circle in a very neat way: by lying, all the time.
The Republicans’ attempt to actually repeal the ACA once they got in power was a catastrophic political decision. After spending all of Barack Obama’s two terms fuming that his health care plans were Marxist death panels, Republicans only barely failed to repeal the law entirely, and spent the 2018 midterm elections claiming they had actually always loved protecting preexisting conditions. They were punished by voters for this, though many Republicans who had embraced this particular lie still won. The lie has persisted to this day: While the GOP is trying to repeal the law that protects preexisting conditions, its members up for reelection claim the party will protect them. How is that possible? Sorry, can’t hear you, going into a tunnel now.
The politics of the ACA have undergone a fascinating shift in recent years. As the Post wrote, Trump’s executive order was an example of “rebranding” rather than repealing the law—that is, he has decided to co-opt the law rather than reject it. “Obamacare is no longer Obamacare, as we worked on it and managed it very well,” said Trump, adding that “we got rid of the worse part of it—the individual mandate.” Trump has done many things to undermine the law, including expanding the sale of “junk” health plans that cover almost nothing. Republicans did not exactly “get rid of” the mandate: The 2017 GOP tax bill zeroed out the penalty for lacking insurance, setting up conservative litigation to invalidate the law entirely: The Supreme Court will hear the case this fall. Moreover, the elimination of the mandate penalty has not had the catastrophic effect that Republicans hoped for and Democrats feared: As the Times reported earlier this month, there has been no “death spiral” in the Obamacare marketplaces, as health insurance coverage held steady in 2019.
As I argued last year, preserving the broad outlines of the ACA is among the most conservative positions one can take on health care policy today. The ACA left intact gaping holes in the employer-based health insurance system that, amid an economically catastrophic pandemic, have never been more obvious. Millions have lost employer-based coverage this year, and millions more will lose it at the end of the year. Small businesses, only 56 percent of which provided health insurance to workers even before the pandemic, are struggling more than ever to afford insurance—and the ACA does not compel them to provide it. The system as it stands is incredibly cruel, expensive, and stupid. No wonder it might start to look good to Trump.